If you are considering a vasectomy, it is important to know that the procedure is typically covered by insurance. However, there may be some exceptions. Patients need to be aware of their coverage and what is required for them to receive reimbursement. In this blog post, we will discuss the basics of vasectomy insurance coverage and what patients need to do in order to have the procedure covered.
Federal and State Laws
Oregon is one of five states (Oregon, Washington, Illinois, Maryland, Vermont) that requires vasectomies to be covered at no cost to patients. Medicaid (OHP, Care Oregon, etc.) also covers vasectomies.
Private insurances typically don’t have a waiting period between when you have your vasectomy consult with your doctor and when you have the procedure. However, most federal or state insurance plans require a 30-day waiting period. If you have federal or state insurance and you undergo your vasectomy prior to the 30-day waiting period it is likely your procedure would not be covered and you would be responsible for the full fee.
Most insurance companies won’t cover vasectomies for patients under 21 years old.
Often, doctors will not perform the procedure on someone younger than 25, BUT, every patient’s case is different so don’t let this deter you. If you’re interested in a vasectomy, get a consult to get your questions answered.
Ultimately, contacting your insurance company and using our insurance verification worksheet is the best way to know if and how much of the procedure will be covered when performed by your doctor at NWIM.
Provide your insurance carrier with the CPT code 55250 and diagnosis code Z30.2.
If you have additional questions, don’t hesitate to schedule your consultation appointment with an NWIM physician today!